A new national survey from The Ohio State University Wexner Medical Center finds that most surgical patients are undermining their own recoveries by failing to complete prescribed at-home physical therapy exercises, a gap clinicians warn can stall healing and even jeopardize surgical outcomes.
Three out of four patients are not finishing their assigned home programs.
According to the survey, 76% of patients did not complete all their prescribed at-home physical therapy sessions, a lapse that clinicians say can slow strength gains, prolong pain, and delay a safe return to normal function.
Physical therapy is not limited to what happens inside the clinic. Recovery depends heavily on what patients do between visits, said Kyle Smith, a physical therapist at Ohio State.
“As physical therapists, we need to educate patients that it is going to take some work on their end to reach the goals they have to ultimately build strength and mobility and decrease the body’s pain sensitivity,” Smith insisted.
The survey, conducted among 1,006 Americans, asked respondents what share of their assigned at-home physical therapy sessions they completed. Only 24% reported completing all their assigned exercises. Another 28% completed 75 to 99 percent of sessions, 27% completed 50 to 74%, 11% completed 25 to 49%, and 8% completed just 1 to 25%.
The reasons for falling short were revealing. Forty percent said they forgot or had no reminders, making that the most common explanation. Thirty-three percent cited lack of time or schedule conflicts. Others said the exercises were boring or repetitive, that they did not see results quickly, or that they feared pain or further injury.
The data also reveal generational differences. Adults 65 and older were more likely than those under 30 to complete all their at-home exercises, 30% compared to 12%. Younger adults were three times more likely to complete only a small fraction of their prescribed sessions.
From a public health perspective, officials noted that these findings raise concerns beyond individual inconvenience. Incomplete rehabilitation can translate into longer recovery timelines, persistent functional limitations, and increased health care utilization. In orthopedic and post-surgical settings, adherence to therapy is directly tied to regaining range of motion, rebuilding muscle strength, and preventing complications such as joint stiffness and chronic pain.
“When it comes to outpatient physical therapy, the majority of progress with rehabilitation takes place at home. Therefore, the home rehab exercise program is of utmost importance,” Chartered Care wrote on X, formerly known as Twitter.
The study authors noted that incomplete rehabilitation does more than slow progress, it can extend recovery timelines, limit long-term mobility, and increase the likelihood of complications that require additional medical attention. They noted that surgeons may repair a joint or stabilize an injury in the operating room, but lasting improvement depends on what happens afterward — repetition, consistency, and disciplined follow-through at home.
Experts said that physical therapy is designed to retrain muscles, restore range of motion, and recalibrate pain responses, but those gains require sustained participation outside the clinic.
While the Ohio State findings focus on recovery behavior, the authors land in a medical system already grappling with disparities in who enters and advances in surgical fields. A 2021 perspective published in the journal Annals of Surgery titled “The State of Diversity in American Surgery” documented persistent underrepresentation of Black, Native American, and Latinx physicians in surgical training.
The authors of that study reported that although Black and Latinx individuals comprise 13.4% and 18.5% of the U.S. population, only 5.6% and 7.1% of surgeons in training are Black and Latinx, respectively
Nationally, 70% of Black surgical residents, 46% of Asian residents, and 25% of Latinx residents reported experiencing discrimination, compared with 13% of white respondents.
Taken together, the newer Ohio State survey and the earlier diversity analysis illustrate two distinct but connected challenges in American surgery: patient adherence on the one hand, and workforce equity on the other. Experts agreed that recovery from surgery is not solely a technical feat performed in an operating room. It depends on sustained effort, clear communication, and trust between patients and providers.
When patients do not complete prescribed therapy, progress can stall. When institutions fail to foster inclusive training environments, representation stalls as well. Both trends carry consequences for outcomes, access, and public confidence in surgical care.
For clinicians like Smith, the message is direct. The hours in the clinic are only the beginning. What patients do at home, consistently and correctly, may determine whether surgery fulfills its promise or falls short.
He said patients often underestimate how much of their recovery hinges on the hours between appointments.
“The one to three hours per week a patient spends in physical therapy pales in comparison to the 168 hours we have in a given week,” Smith outlined. “And that one to three hours patients are physically in the clinic is not enough to make big changes in the grand scheme of things.”